'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs fearful over death certificates

GPs are increasingly reluctant to sign death certificates because they are 'watching their backs' in fear of litigation, a coroner is claiming.

Mr John Pollard, coroner

for South Manchester, said the legacy of Harold Shipman had led to a huge rise in the number of inquests and caused delays.

The number of inquests in the district had risen from 200 in 1995 to 664 in 2006.

Mr Pollard told Pulse: 'There are two reasons more deaths are reported – the first is that under the new GP contracts the doctors are statistically far less likely to be on duty and available to issue a medical certificate on cause of death.

'The second is a remnant of Shipman. They are not prepared to risk their good name by giving a cause of death that may be challenged by relatives.'

He added: 'We live in an increasingly litigious society where professionals have to watch their own backs.'

Dr Kailash Chand, secretary of West Pennines LMC, said: 'That was always going to happen after Shipman and there's no doubt in my mind that it will have had an effect. When the Government comes to implement Dame Janet Smith's recommendations, they have to be realistic – that's the lesson.'